| NPI | 1508485301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA PSY5000514) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: RI PS01827) |
| Enumeration Date | 2020-04-11 |
| Last Update Date | 2024-12-03 |